Thursday, August 14, 2014

Vitamin K Shot at Birth -- The Controversy Reignites

Doctors' Office Tower at Monroe Carell, Jr. Ch...
Doctors' Office Tower at Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tenn. (Photo credit: Wikipedia)

By Dr. Mercola
The controversy surrounding vitamin K shots at birth recently surfaced when physicians at Monroe Carell Jr. Children's Hospital at Vanderbilt reported seeing a rise in late-onset vitamin K deficiency bleeding (VKDB) in young infants.1
The rise is blamed on increasing numbers of parents declining to have their babies receive a vitamin K shot at birth—a routine practice in the US since 1961.2
In a Pediatric Neurology3 article, the researchers call for a state and national tracking system to monitor how many infants are getting the vitamin K shot at birth.
Writing for Mother Jones,4 Chris Mooney cites an article I wrote in 2010 in which I recommend giving oral vitamin K instead of an injection form. The article in question was actually an interview (at top of page) with Cees Vermeer, PhD, who is generally recognized as the leading vitamin K expert in the world.
Mooney goes on to lambast me for raising questions about the safety of vaccinations, and weaves together a picture in which parents who are cautious about vaccines—courtesy of my awareness-raising campaign—also take issue with vitamin K injections.
His tone doesn't surprise me. What many people probably don't know is that Chris Mooney is a well-documented skeptic who worked for the Center for Inquiry,5 an organization whose founder has even been critical of their practices, stating "I consider them atheist fundamentalists.

For those who are not aware, the 'skeptics' are a small but well-organized group that appear to despise alternative medicine and consider it to be similar to a religion where belief trumps science.  They have been quite aggressive in attacking doctors who practice alternative medicine for many years.

The CFI founder goes on to say, "They're anti-religious, and they're mean-spirited, unfortunately. Now, they're very good atheists and very dedicated people who do not believe in God. But you have this aggressive and militant phase of atheism, and that does more damage than good."6
Theoretical physicist Peter Higgs has expressed similar criticism against another 'skeptic', biologist Richard Dawkins, calling Dawkins' vitriolic stance against those expressing religious views "embarrassing," saying Dawkins is "almost a fundamentalist himself, of another kind."7
Mooney's podcast8 is very dogmatic, some comments in the resulting storm have gone so far as to say I'm guilty of infanticide and should be in jail—all because I suggest vitamin K is likely to be better given orally instead of via injection.

Is Vitamin K Injection the Best Way to Prevent Vitamin K Deficient Bleeding?

Vitamin K is not a blood coagulant in and of itself, as Mooney incorrectly states, but it is an important catalyst in the coagulation cascade. Without vitamin K, the coagulation cascade stops before the clot forms.
When this occurs in an infant, they can develop uncontrolled bleeding anywhere in their body, including the brain. There are three basic categories of vitamin K deficiency bleeding (VKDB), classified according to age at onset:9
  1. Early onset: Within the first day of life. Early VKDB is exceedingly rare, and is typically related to medicines used by the mother that inhibit vitamin K activity
  2. Classic: Within the first week of life. This is the most common form, occurring in 0.25-1.5 percent of infants who have not received vitamin K at birth
  3. Late onset: From the second week of life up to six months of age. Occurs in 5-7 out of every 100,000 infants not given prophylactic vitamin K, and is indicative of inadequate intake of vitamin K, malabsorption issues, and/or impaired utilization due to an underlying liver disorder
While vitamin K is important to prevent brain bleeding in newborns, I strongly believe there are safer and non-invasive ways to normalize an infant's vitamin K levels that don't require a potentially traumatic injection given in massive mega dose quantities.
It's well worth noting that the amount of vitamin K injected into newborns is 20,000 times the newborn's typical level at birth.10 It seems most odd that conventional medicine repeatedly warns against mega dosing vitamins in adults, yet doesn't raise any questions at all about the practice of giving a massive dose of a synthetic vitamin to an hours-old infant.
Also, infants are more or less universally born with low vitamin K levels. Is it then really reasonable to categorize it as a true deficiency state? Might there be a fundamental biological reason for being born with an initially low vitamin K level?
The truth is, we don't know. Researchers determined that giving vitamin K at birth worked to virtually eliminate hemorrhaging, and that more or less marked the end of the thought process.
Besides the question of whether or not a one-time mega-dose is the most appropriate route, the vitamin K injection also contains potentially toxic additives like aluminum. Many experts believe that aluminum is more toxic than mercury.
The injection is also loaded with preservatives,11 such as polysorbate 80 (known as Tween 80, which has estrogenic effects) and propylene glycol (a skin irritant).
As explained by Dr. Natasha Campbell-McBride, the introduction of toxins in combination with poor gut flora (which is a problem that affects a great number of infants born these days) can lead to developmental problems. It doesn't matterwhere these toxins come from—ideally, you'd want to avoid exposing your infant to any.

Synthetic Vitamin K Injection Is Not Risk-Free as Claimed

As noted in a 2001 article in Pediatric Pharmacotherapy,12 the standard practice in the US is to administer an intra-muscular injection of 0.5-1 milligram (mg) of phytonadione within one hour of birth. Phytonadione is a fat-soluble synthetic vitamin K1 analog.
Ironically, the phytonadione13, 14 drug insert warns that it can cause severe, sometimes fatal, allergic reactions when injected into a muscle or vein,15, 16 and is ideally taken by mouth or injected under the skin. Signs of an allergic reaction include hives, trouble breathing, swelling of the face, lips, tongue, or throat.
One recent PLOS ONE study17 looking into this issue found that allergic reactions appear to be linked to the preservatives in the vitamin K1 injection:
"[S]erious anaphylaxis-like symptoms appeared in beagle dogs after the administration of vitamin K1 injection for the first time. The plasma histamine concentration increased, and blood pressure decreased sharply. After sensitization, dogs were challenged with vitamin K1 injection and displayed the same degree of symptoms as prior to sensitization. However, when the vitamin K1 injection-sensitized dogs were challenged with a vitamin K1-fat emulsion without solubilizers such as Tween-80, the abnormal reactions did not occur...
Our results indicate that the adverse reaction induced by vitamin K1 injection is an anaphylactoid reaction, not anaphylaxis. Vitamin K1 injection induces the release of inflammatory factors via a non-IgE-mediated immune pathway, for which the trigger may be the solubilizer."
Even more ironic, pregnant women are warned that it is not known whether taking phytonadione might harm their baby if taken during pregnancy or while breast feeding.18 The recommended daily allowance (RDA) for infants 0-6 months is 2 micrograms (mcg) per day, so they are receiving a dose that is 5,000 times the RDA.
The RDA for adult women is 90 mcg/day. If you're an adult suffering minor bleeding due to warfarin use, a one-time dose of 2.5-5 mg is recommended. If an adult overdoses on phytonadione, they're advised to call Poison Control. And yet newborn babies are given a 1 mg injection whether they in need of it or not. This is a highly irrational approach anyway you look at it. It's simply not supported by the science in any way shape or form.

The Case for Longer-Term Oral Vitamin K1 Supplementation

As noted in Pediatric Pharmacotherapy:19
"Oral vitamin K administration would appear to offer several advantages for routine VKDB prophylaxis... It has been suggested that longer regimens of oral vitamin K would prevent late VKDB while avoiding the concerns with IM [intramuscular] use. In 1992, The Netherlands adopted a regimen of 1 mg oral vitamin K at birth, followed by daily doses of 25 mcg from 1 week to 3 months of age in breastfed infants.
Surveillance data collected on infants receiving this regimen have revealed no cases of late VKDB.
Another alternative regimen now used in Switzerland consists of weekly 1 mg oral doses for two or three months with the Konakion MM® preparation. The primary disadvantages of these methods are the reliance on parent compliance. Giving an oral vitamin should not be looked at as so difficult, especially with the frequency of pediatric visits."
The paper also notes that: "It is clear that oral administration of vitamin K produces adequate serum concentrations for the prevention of classic VKDB. While no oral liquid preparation is available in the United States, the injectable product has been found to be safe and effective when given by the oral route." In case you missed the yellow highlight above, there were zero, not one single episode of VKDB in infants given the oral dose. The concerns that Mooney brings up about the increase in VKDB are clearly related to noncompliance with the oral route, not to its efficacy.
To me, it appears obvious that if the US made an oral vitamin K1 supplement to be taken for the first three months of life, that would be the safest method to avoid vitamin K deficient bleeding in infants. Not only should vitamin K1 be given orally, but vitamin D and vitamin K2 as well, since most parents are so adamant about shielding their children from the sun. As a result of this widespread sun-phobia, most children are vitamin D deficient from birth.20 According to one recent study,21 breastfed infants should ideally begin receiving vitamin D supplementation at birth. The study supports using a dose of 400 IUs of vitamin D per day for the first nine months of the baby's life.

Why Are American Doctors so Clueless?

The infant mortality rate22 in the US is absolutely abysmal, ranking in 34th place after countries like Singapore, the Czech Republic, South Korea, Croatia, and Cuba. This despite having "the best" medicine in the world—and spending more than any other country on health care to boot. It's quite clear that Americans have a lot to learn with regards to what makes for a healthy baby.
Long-term health does not at all appear to be correlated with getting an abundance of injections. We're missing something, and I believe that something is really fundamental and basic. Many Americans do not trust their bodies to do what nature intended their bodies to do. The human body is imbued with the power to self heal, if given adequate support.
Enormous damage was done when physicians used forceps to pull babies out of the womb. And for quite some time physicians were (and some still are) vehemently opposed to breastfeeding—the perfect food for an infant! Eventually, mainstream medicine was forced to acknowledge the dangers of forceps however, and admit the benefits of breastfeeding. Kangaroo Care is the current hot button.

There is progress, however. Some hospitals offer a less brutal C-section that allows the baby to stay with the mother and breastfeed sooner. The benefits to mother and baby are astounding. Yet most hospitals still refuse to allow it because it's time consuming and requires a change in staffing practice. I believe the ramifications of this attitude of "efficiency first" is taking its toll and showing up in our infant mortality rates.

Keeping It Simple and Natural Goes a Long Way

I believe simple strategies like having a natural birth, not cutting the cord too soon, immediately holding your baby with skin-to-skin contact, and giving your child oral vitamin K1, K2, and D for the first several months could make an important difference in the US infant mortality statistics. Recent research23 has shown that vaginal birth actually "triggers the expression of a protein in the brains of newborns that improves brain development and function in adulthood." The expression of this protein is impaired in the brains of children delivered by caesarean section.
Caesarean delivery is also associated with a greater risk of autoimmune dysfunction, diabetes, allergies, and other childhood diseases,24 revealing the importance of vaginal delivery to transfer health-promoting bacteria from mother to child. Other studies25, 26 have found that delaying the clamping of the cord, and allowing blood to flow between the placenta and the child for at least one minute after birth, significantly raises the child's iron and hemoglobin level. If there is a benefit to cutting the umbilical cord before the cord stops pulsing, I have not found it. As noted in a Committee Opinion paper by the American College of Obstetricians and Gynecologists:27
"Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth. This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life."
The video below is from the article "What's the Hurry? The Benefits of Waiting to Cut the Umbilical Cord After Birth" published by Bastyr University.28 Again, it comes down to NOT doing what's convenient for the doctor, but what's in the best long-term interest of the mother and child... It's also worth noting that since children are born with low vitamin K1 levels, it is important to make sure that the birth is as easy and non-traumatic as possible. Use of forceps, vacuum extraction, and drugs such as epidurals and spinal anesthesia all raise the risk of bleeding in your baby, thereby necessitating the use of vitamin K right upon birth. Circumcision is also a risk factor that can lead to excessive bleeding, if done too early.

Closer Attention Must Be Paid to Mother and Child's Gut Health

We also need to pay closer attention to gut health, both in the mother and the infant. Part and parcel of raising a healthy child is to breastfeed for at least six months or longer, if at all possible. Research29 has repeatedly demonstrated that breastfed babies have very different bacteria in their guts compared to formula-fed babies, and the colonization of these health-promoting bacteria helps support strong immune function. The same applies to breastfeeding, which is known to colonize your baby's gut with beneficial bacteria. Ideally, the breastfeeding mother should be eating plenty of fresh organic vegetables, which are loaded with vitamin K1.
Studies30, 31, 32 have shown that adults raised on formula rather than breast milk during the early months of life have higher rates of chronic inflammation. Even an occasional bottle of formula has been shown to have a detrimental effect by raising C-reactive protein. 

A Complex Issue That Has a Number of Simple Solutions

The question is not if it is important to optimize your baby's vitamin K1 because it is necessary to prevent infants dying from brain bleeds. The real question is how this is best achieved. In my view, there are strong arguments against injecting an hour-old infant with a potentially allergenic substance, when you can safely administer the vitamin orally. Oral administration also appears to be quite comparable in terms of effectiveness.
One Cochrane systematic review34 found that: "A single oral compared with a single intramuscular dose resulted in lower plasma vitamin K levels at two weeks and one month, whereas a 3-dose oral schedule resulted in higher plasma vitamin K levels at two weeks and at two months than did a single intramuscular dose." Since vitamin K is non-toxic, there is no danger of overdosing or having a bad reaction when administered orally. Oral doses can range from 1 mg per week to 250 mcg (quarter of 1 mg) every day.
I also believe your lifestyle before and during pregnancy can have a lot to do with raising or lowering your child's risk of VKDB and other health problems, not to mention the method of delivery itself. It makes sense that using drugs and methods that are "rough" on your baby will increase the likelihood of your child suffering trauma and subsequent bleeding, raising the necessity for vitamin K. Ideally, you'd want to work with a compassionate midwife or doctor who is willing to work around your baby's schedule rather than their own.
Last but not least, unless environmental toxins such glyphosate are now causing children to be dangerously deficient in vitamin K, there's reason to believe that Nature has a plan—there's some reason why babies are born with low vitamin K stores, and why the level slowly rises. Also, remember that you can safely and naturally increase your infant's vitamin K levels if you are breastfeeding by increasing your own vitamin K levels. Vitamin K1 is found in green vegetables. Of equal importance is to optimize your gut health and vitamin D levels. Vitamin K2 is produced by certain gut bacteria, and works synergistically with vitamin D to optimize your and your baby's health (both while in utero, and during breastfeeding).

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